A scoping review of the links between early childhood caries and clean water and sanitation: the Sustainable Development Goal 6.

INTRODUCTION: The United Nation's Sustainable Development Goal (SDG) 6 calls for universal access to clean water, sanitation and hygiene (WASH), which are crucial elements of health and well-being and fundamental for a life in dignity. Early childhood caries (ECC) is a preventable disease affecting health and quality of life of millions of young children worldwide. This scoping review aims to explore the connection between ECC and access to clean water and sanitation. METHODS: This scoping review, registered on the Open Science Framework and following PRISMA-ScR guidelines, conducted a thorough search in databases (PubMed, Web of Science, Embase, Google Scholar, SciELO) and websites (via Google) in November 2023. The search, without date limitations, targeted studies in English and Spanish linking ECC to SDG6. Exclusions were made for studies solely focusing on ECC without a direct connection to clean water and sanitation. Descriptive statistics summarized the retrieved papers. RESULTS: The initial search yielded 303 articles. After removing duplicates, 264 articles remained for title and abstract screening after which 244 were excluded and one report was added through citation searching. The 21 remaining articles underwent full text review. There were no studies on a direct association between access to clean water and sanitation and the prevalence of ECC. There were nine studies that showed indirect associations between ECC and access to clean water and sanitation through the links of: water and sanitation access as a marker for poverty (n = 1), water consumption as a feeding practice (n = 4), and the effectiveness of water fluoridation (n = 4). These were used to develop a conceptual model. CONCLUSIONS: While it is conceivable that a direct link exists between ECC and access to clean water and sanitation, the available body of research only offers evidence of indirect associations. The exploration of potential pathways connecting water access to ECC warrants further investigation in future research.

Rational perspectives on risk and certainty for dentistry during the COVID-19 pandemic

Clinical dental practice exposes the dental team and patients to infectious airborne disease agents, due to the close contact during clinical care, and the infectious aerosols from most dental procedures. The U.S. Centers for Disease Control and Prevention (CDC), the American Dental Association (ADA) and other organizations developed recommendations to address the specific risk profile of SARS-CoV-2 transmission, adding additional protective measures to established standard precautions. When deciding on re-opening of dental services it is important to remember that so far, no reliable data on work-related infection risk for dental personnel are available. Combined with other uncertainties it seems prudent to follow four key principles: 1) All patients should be considered as potentially infectious; 2) procedures generating aerosols should be avoided, limited or closely managed; 3) infection control should be increased according to recommendations; 4) PPE measures should be maximized. Dental teams must follow ethical principles in providing the best possible and safe dental care. Yet, as business owners, they are facing existential impacts from reduced patient visits and loss of income resulting from service limitations. Reconciling the conflict of risking their life or their livelihood under the COVID-19 pandemic is not a welcome or easy choice. Decisions must be based on best possible evidence, and need to be revisited as the pandemic, and economic conditions change. COVID-19 also unmasked the challenges of access and financial coverage for dental care in the U.S. Sustainable preparation for future pandemics should consider reforms towards a more equitable system with better coverage.